title: Co-morbidities and hyperinflation are independent risk factors of all-cause mortality in very severe COPD.
abstract: BACKGROUND
  COPD is a multi-component disease that is not sufficiently reflected by FEV1 alone. We studied in patients with very severe COPD, which dimensions of the disease, including co-morbidities, dominate prognosis.
  
  
  METHODS
  In patients with FEV1 < 30% predicted, anthropometric, laboratory, spirometric and body plethysmographic data, smoking status, alcohol consumption, the level of dyspnoea and exercise performance were assessed. Co-morbidities were categorized by the Charlson-index and the COPD-specific co-morbidity test (COTE). The prognostic value of multiple dimensions was explored using uni- and multivariate survival analyses regarding death from any or respiratory cause.
  
  
  RESULTS
  Among 209 patients included (58/151 female/male; FEV1 25.0 (22.0-26.9)%predicted), arterial hypertension (54.1%), hyperlipidemia (38.3%) and diabetes (19.6%) were most common, 57.9% showing a COTE-index of ≥ 1 point. During follow-up (28 (14-45) months), 121 patients had died, mostly (56.2%) due to respiratory causes. Age, BMI, the ratio of residual volume to total lung capacity (RV/TLC), co-morbidities in terms of the COTE- and Charlson-index, but not FEV1, were significantly associated with all-cause and respiratory mortality. The association of the median values of the Charlson- (HR 1.911 [95%-CI 1.338-2.730]) and COTE-index (HR 1.852 [95%-CI 1.297-2.644], p < 0.001 each) with mortality was similar and stronger when combined with age. In multivariate analyses, only RV/TLC and co-morbidities were independent risk factors of all-cause mortality (p < 0.05 each).
  
  
  CONCLUSIONS
  In very severe COPD, resting hyperinflation and co-morbidities provide the major prognostic information, whereas the association of the recently introduced COTE-index with mortality was similar to that of the established Charlson-index and even stronger when including age.
authors.affiliation: 1Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Centre , Rosenheim , Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Budweiser
authors.forename: Martina
authors.initials: M
authors.lastname: Harlacher
authors.forename: Michael
authors.initials: M
authors.lastname: Pfeifer
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: Jörres
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology*; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D012115:Residual Volume; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D014109:Total Lung Capacity
keywords: co-morbidity score; long-term survival; prognostic factors; residual volume